Hepatitis B and C testing: people at risk of infection

Appendix D Gaps in the evidence

The Programme Development Group (PDG) identified a number of gaps in the evidence related to the programmes under examination, based on an assessment of the evidence. These gaps are set out below.

1. There is a lack of robust, quantitative studies on identifying, testing and treating hepatitis B and C (that is, studies that are applicable to the UK context). In particular there is a lack of reliable data on:

a) the number of people in the UK with chronic hepatitis B and C. In particular, there is no national information on the number of children infected.

b) local information on the number of people with chronic hepatitis B and C.

c) interventions to increase hepatitis B and C testing among migrant populations.

d) interventions to increase hepatitis B and C testing in non-health settings, for example, prisons.

2. There is a lack of qualitative studies on hepatitis B and C, including studies focused on:

a) cultural issues which may act as a barrier to testing and treatment.

b) knowledge of, barriers against, and facilitators for hepatitis C testing and treatment among migrant populations.

c) knowledge of, barriers against, and facilitators for preventing hepatitis B and C among men who have sex with men.

d) knowledge of, barriers against, and facilitators for improving the prevention of maternal transmission of hepatitis B.

e) knowledge of, barriers against, and facilitators for preventing hepatitis B among injecting drug users.  

f) how former drug users, both from a service user and provider perspective, regard testing for hepatitis.

g) the views, perspectives and experiences of hepatitis B and C testing among people whose past behaviour has put them at risk but who choose not to disclose this information. This includes people who have previously injected drugs or worked as commercial sex workers.

h) the views, perspectives and experiences of hepatitis B and C testing among practitioners and people at increased risk of infection, according to the practitioner's level and type of knowledge.

i) prisoners' views of hepatitis testing and treatment and the views of those working with them.

j) the acceptability of different sampling methods for testing for hepatitis.

k) factors which encourage people to have a liver biopsy or discourage them from this.

l) the knowledge GPs have regarding identification of at-risk patients.   

m) why people referred by GPs for a hepatitis test drop out of appropriate care pathways and whether or not an integrated services/one-stop-shop approach would improve uptake rates.

n) understanding of hepatitis B and C care pathways.

3. There is a lack of evidence on the role of the voluntary sector in promoting and offering tests for hepatitis B and C.

4. There is a lack of evidence on what is happening in the 'real world'. This includes the views of people:

a) at risk of hepatitis B and C.

b) who have been identified and/or tested and/or treated.

c) who have dropped out at different stages of the care pathway.

5. There is a lack of qualitative and quantitative evidence on the acceptability of dried blood spot testing among different communities.

6. There is a lack of evidence on how hepatitis B and C status could be assessed when testing for other diseases and blood-borne viruses.

The Group made 12 recommendations for research into areas that it believes will be a priority for developing future guidance.